Causal mediation analysis decomposition of between-hospital variance

Causal variance decompositions for a given disease-specific quality indicator can be used to quantify differences in performance between hospitals or health care providers. While demonstrate variation of care, causal mediation analysis study pathways leading the institutions. This raises question whether two approaches combined decompose between-hospital an outcome type that mediated through process (indirect effect) and remaining due all other (direct effect). For this purpose, we derive decomposition variance, discuss its interpretation, propose estimation approach based on generalized linear mixed models mediator. We estimators simulation use administrative data kidney cancer Ontario.